I
nte
rna
t
io
na
l J
o
urna
l o
f
P
u
bli
c
H
ea
lt
h Science
(
I
J
P
H
S)
Vo
l.
10
,
No
.
2
,
J
u
n
e
2
0
2
1
,
p
p
.
2
5
8
~
2
6
4
I
SS
N:
2
2
5
2
-
8806,
DOI
: 1
0
.
1
1
5
9
1
/i
j
p
h
s
.
v
1
0
i2
.
2
0
6
7
0
258
Jo
u
r
n
a
l h
o
mep
a
g
e
:
h
ttp
:
//ij
p
h
s
.
ia
esco
r
e.
co
m
Risk facto
rs a
ss
o
c
ia
ted
w
ith
the
dev
elo
p
m
en
t
o
f
den
tal ca
ries in
Bulg
a
ria
n childre
n
Do
brin
k
a
Da
m
y
a
no
v
a
1
,
Va
le
ntina
Veli
k
o
v
a
2
1
De
p
a
rtme
n
t
o
f
P
e
d
iatric De
n
tal
M
e
d
icin
e
,
F
a
c
u
lt
y
o
f
De
n
tal
M
e
d
icin
e
,
M
e
d
ica
l
Un
iv
e
rsit
y
o
f
V
a
rn
a
,
Bu
lg
a
ria
2
De
p
a
rtme
n
t
o
f
M
a
n
a
g
e
m
e
n
t
a
n
d
A
d
m
in
istratio
n
,
F
a
c
u
lt
y
o
f
M
a
n
a
g
e
m
e
n
t,
Un
iv
e
rsit
y
o
f
Eco
n
o
m
ics
,
Bu
lg
a
ria
Art
icle
I
nfo
AB
ST
RAC
T
A
r
ticle
his
to
r
y:
R
ec
eiv
ed
Sep
3
0
,
2
0
2
0
R
ev
i
s
ed
Feb
1
6
,
2
0
2
1
A
cc
ep
ted
Mar
1
0
,
2
0
2
1
T
h
e
p
u
rp
o
se
o
f
th
is
stu
d
y
w
a
s
to
e
x
a
m
in
e
th
e
risk
fa
c
to
rs
a
ss
o
c
iate
d
w
it
h
th
e
d
e
v
e
lo
p
m
e
n
t
o
f
d
e
n
tal
c
a
ries
in
c
h
il
d
re
n
i
n
Bu
lg
a
ria.
T
h
e
re
se
a
r
c
h
h
a
s
b
e
e
n
c
a
rried
o
u
t
a
t
th
e
F
a
c
u
lt
y
o
f
De
n
tal
M
e
d
icin
e
,
i
n
t
h
e
p
e
rio
d
2
0
1
5
-
2
0
1
6
,
w
it
h
th
e
p
e
rm
issio
n
o
f
th
e
Un
iv
e
r
sity
S
c
ien
ti
f
ic
Re
s
e
a
rc
h
C
o
m
m
it
tee
a
n
d
in
f
o
rm
e
d
c
o
n
se
n
t
sig
n
e
d
b
y
e
a
c
h
p
a
r
e
n
t.
T
h
e
su
b
jec
t
o
f
o
b
se
rv
a
ti
o
n
w
a
s
p
a
re
n
ts
o
f
c
h
il
d
re
n
f
ro
m
V
a
rn
a
re
g
io
n
in
Bu
lg
a
ria.
T
h
e
r
e
s
u
lt
s
w
e
re
sta
ti
stica
ll
y
p
ro
c
e
ss
e
d
w
it
h
S
P
S
S
v
.
2
0
.
0
,
u
si
n
g
v
a
riatio
n
a
n
d
c
o
m
p
a
riso
n
(c
h
i
-
sq
u
a
re
)
a
n
a
ly
z
e
s.
F
o
r
sig
n
if
i
c
a
n
c
e
le
v
e
l
w
e
a
ss
u
m
e
p
<
0
.
0
5
.
T
h
e
v
o
lu
m
e
o
f
o
b
se
rv
a
ti
o
n
e
n
c
o
m
p
a
ss
e
s
1
0
0
p
e
rso
n
s.
Un
it
s
o
f
o
b
se
rv
a
ti
o
n
a
re
p
a
ti
e
n
ts
a
g
e
d
th
re
e
to
six
y
e
a
rs
w
it
h
th
e
n
e
e
d
f
o
r
p
re
v
e
n
ti
o
n
a
n
d
trea
tm
e
n
t
o
f
d
e
n
tal
c
a
ries
o
f
th
e
p
ri
m
a
r
y
d
e
n
ti
ti
o
n
.
T
h
e
re
g
istratio
n
w
a
s
d
o
n
e
in
a
sp
e
c
iall
y
d
e
v
e
lo
p
e
d
q
u
e
sti
o
n
n
a
ire,
i
n
c
lu
d
in
g
2
2
q
u
e
sti
o
n
s,
e
a
c
h
w
it
h
t
h
e
p
o
s
sib
il
it
y
o
f
m
o
re
th
a
n
o
n
e
a
n
sw
e
r.
In
p
r
o
c
e
ss
in
g
th
e
o
b
tain
e
d
d
a
ta,
S
t
u
d
e
n
t'
s
c
rit
e
rio
n
w
a
s
u
se
d
to
c
o
m
p
a
re
th
e
m
e
a
n
v
a
lu
e
s
o
f
t
w
o
in
d
e
p
e
n
d
e
n
t
sa
m
p
les
.
In
a
c
o
m
p
a
ra
ti
v
e
a
n
a
l
y
sis
o
f
th
e
re
su
lt
s,
w
e
f
o
u
n
d
th
a
t
7
1
.
0
1
%
o
f
c
h
il
d
re
n
a
g
e
d
th
re
e
to
six
y
e
a
rs
v
isit
a
d
e
n
ti
st,
a
n
d
p
a
ti
e
n
ts
u
se
f
lu
o
rid
e
o
n
ly
in
th
e
f
o
rm
o
f
to
o
t
h
p
a
ste
c
o
n
tain
i
n
g
f
lu
o
rid
e
.
W
h
e
n
stu
d
y
in
g
th
e
k
n
o
w
led
g
e
a
n
d
b
e
h
a
v
io
r
o
f
p
a
re
n
ts
in
t
h
e
d
irec
ti
o
n
o
f
risk
f
a
c
to
rs
f
o
r
th
e
d
e
v
e
lo
p
m
e
n
t
o
f
d
e
n
tal
c
a
ries
a
n
d
o
ra
l
p
ro
p
h
y
lax
is,
n
e
e
d
f
o
r
a
n
e
w
a
p
p
ro
a
c
h
o
f
p
e
d
iatric
d
e
n
ti
st
s
h
a
s
b
e
e
n
f
o
u
n
d
,
f
o
c
u
se
d
o
n
p
ro
g
ra
m
m
in
g
p
re
v
e
n
ti
v
e
a
n
d
n
o
n
-
in
v
a
siv
e
trea
tme
n
t
o
f
c
h
il
d
re
n
a
c
c
o
rd
in
g
t
o
t
h
e
ir
in
d
iv
i
d
u
a
l
n
e
e
d
s
.
K
ey
w
o
r
d
s
:
Den
tal
ca
r
e
Den
tal
ca
r
ies
Or
al
h
ea
lt
h
P
r
im
ar
y
tee
th
Su
r
v
e
y
s
a
n
d
q
u
est
io
n
n
air
es
T
h
is
is
a
n
o
p
e
n
a
c
c
e
ss
a
rticle
u
n
d
e
r th
e
CC B
Y
-
SA
li
c
e
n
se
.
C
o
r
r
e
s
p
o
nd
ing
A
uth
o
r
:
Do
b
r
in
k
a
Da
m
y
a
n
o
v
a
Dep
ar
t
m
en
t o
f
P
ed
iatr
ic
Den
ta
l M
ed
icin
e
,
Facu
lt
y
o
f
Den
ta
l M
ed
icin
e
Me
d
ical
Un
i
v
er
s
it
y
o
f
Var
n
a
8
4
,
T
s
ar
Osv
o
b
o
d
itel,
9
0
0
0
V
ar
n
a,
B
u
lg
ar
ia
E
m
ail: d
r
_
d
a
m
y
a
n
o
v
a
@
ab
v
.
b
g
1.
I
NT
RO
D
UCT
I
O
N
Hea
lth
y
te
m
p
o
r
ar
y
teet
h
s
u
p
p
o
r
t th
e
f
u
n
ctio
n
s
o
f
th
e
ch
e
w
i
n
g
ap
p
ar
atu
s
,
th
e
co
r
r
ec
t
p
r
o
n
u
n
ciatio
n
o
f
w
o
r
d
s
,
h
av
e
ae
s
t
h
etic
s
i
g
n
i
f
i
ca
n
ce
a
n
d
ar
e
i
m
p
o
r
tan
t
f
o
r
th
e
d
e
v
elo
p
m
e
n
t
o
f
p
er
m
a
n
e
n
t
tee
th
.
C
ar
ies
o
f
te
m
p
o
r
ar
y
teet
h
i
s
t
h
e
m
o
s
t c
o
m
m
o
n
ca
u
s
e
o
f
i
m
p
air
m
en
t o
f
th
e
s
e
f
u
n
ctio
n
s
[
1
]
.
I
m
p
r
o
p
er
b
eh
av
io
r
g
iv
e
s
r
is
e
to
a
p
r
o
ce
s
s
th
at
allo
w
s
b
ac
t
er
ial
in
v
o
lv
e
m
e
n
t
a
n
d
r
ea
liza
tio
n
o
f
ca
r
io
u
s
lesi
o
n
s
[
2
]
.
T
h
e
co
r
r
ec
tio
n
i
n
a
ch
ild
’
s
b
eh
a
v
io
r
h
elp
s
to
s
el
f
-
co
n
tr
o
l
th
e
o
r
al
en
v
ir
o
n
m
e
n
t
an
d
p
r
ev
en
ts
t
h
e
d
ev
elo
p
m
en
t
o
f
ca
r
io
u
s
lesi
o
n
s
[
3
]
.
Me
th
o
d
s
f
o
r
n
o
n
-
o
p
er
ativ
e
an
d
o
p
er
ativ
e
p
r
ev
en
tiv
e
tr
e
at
m
e
n
t
h
a
v
e
b
ee
n
d
ev
elo
p
ed
,
r
eq
u
ir
in
g
c
h
an
g
e
s
i
n
th
e
p
r
o
to
co
l f
o
r
tr
ea
tm
e
n
t o
f
c
ar
ies in
te
m
p
o
r
ar
y
teet
h
[
4
]
.
A
cc
o
r
d
in
g
to
Sh
i
n
H
y
e
-
S
u
n
et
a
l.
th
e
q
u
esti
o
n
n
air
e
d
ev
el
o
p
ed
b
y
th
e
m
o
n
t
h
e
ch
ild
'
s
p
er
ce
p
tio
n
s
w
a
s
in
d
ep
en
d
e
n
tl
y
r
elate
d
to
d
en
tal
ca
r
ies.
T
h
e
au
t
h
o
r
s
ca
m
e
to
th
e
co
n
clu
s
io
n
t
h
at
t
h
e
q
u
e
s
tio
n
n
air
e
f
o
r
s
el
f
-
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t.
J
.
P
u
b
lic
Hea
lth
Sci.
I
SS
N:
2
2
5
2
-
8806
R
is
k
fa
cto
r
s
a
s
s
o
cia
ted
w
ith
th
e
d
ev
elo
p
men
t
o
f d
en
ta
l c
a
r
ies in
…
(
Do
b
r
in
k
a
Da
mya
n
o
v
a
)
259
ass
es
s
m
en
t
o
f
ch
i
ld
r
en
'
s
p
er
c
ep
tio
n
s
ca
n
b
e
a
p
r
ac
tical
to
o
l
f
o
r
as
s
ess
in
g
th
e
s
u
b
j
ec
tiv
e
h
ea
lt
h
o
f
t
h
e
o
r
al
ca
v
it
y
a
m
o
n
g
Ko
r
ea
n
c
h
ild
r
en
ag
ed
8
to
1
4
y
ea
r
s
[
5
]
.
Scien
ti
s
ts
s
u
c
h
as
Su
m
a
So
g
,
H.
P.
et
a
l.
m
ak
e
a
n
ass
e
s
s
m
en
t
o
f
th
e
ex
is
ti
n
g
k
n
o
w
led
g
e
,
attitu
d
es
an
d
p
r
ac
tices
o
f
"
o
r
al
ca
v
it
y
h
ea
lt
h
"
in
t
h
e
p
r
ev
en
tio
n
o
f
ea
r
l
y
ch
ild
h
o
o
d
ca
r
ies
(
E
C
C
)
a
m
o
n
g
p
ar
en
t
s
o
f
ch
ild
r
en
i
n
th
e
cit
y
o
f
B
elag
av
i
[
6
]
.
Oth
er
au
th
o
r
s
,
s
u
ch
a
s
Ai
m
ée
an
d
Da
m
e
[
7
]
co
n
d
u
cted
a
m
eta
-
a
n
al
y
s
i
s
o
f
th
eir
r
esu
l
ts
.
T
h
is
r
ev
ie
w
an
d
m
e
ta
-
a
n
al
y
s
i
s
w
er
e
u
n
d
er
ta
k
en
b
y
r
esear
ch
er
s
to
ass
e
s
s
th
e
r
esp
o
n
s
iv
e
n
es
s
o
f
v
alid
ated
q
u
alit
y
o
f
lif
e
q
u
e
s
t
io
n
n
air
es
r
elate
d
to
o
r
al
ca
v
ity
h
ea
lt
h
r
elate
d
to
d
en
tal
ca
r
ies
in
ter
v
en
tio
n
s
i
n
ch
ild
r
en
,
ad
o
lescen
t
s
,
an
d
y
o
u
n
g
p
atie
n
ts
.
T
h
e
f
i
n
d
in
g
s
o
f
a
u
t
h
o
r
s
s
u
c
h
as
Villa
lo
b
o
s
-
Gal
v
is
F.H.
et
a
l.
s
u
g
g
est
t
h
at
t
h
e
m
o
d
if
ied
3
6
-
p
o
s
itio
n
m
o
d
el
h
as
s
ati
s
f
ac
to
r
y
r
eliab
il
it
y
an
d
v
al
id
it
y
o
f
a
n
u
m
b
er
o
f
f
ac
to
r
s
s
t
u
d
ied
b
y
t
h
e
m
.
T
h
er
ef
o
r
e,
a
r
esear
ch
s
cr
ee
n
i
n
g
m
o
d
el
ca
n
b
e
a
v
al
u
ab
le
to
o
l
f
o
r
s
cr
ee
n
i
n
g
p
er
ce
p
tio
n
s
f
o
r
o
r
al
ca
v
it
y
d
is
ea
s
es
[
8
]
,
[
9
]
.
Nu
m
er
o
u
s
p
u
b
lic
h
ea
lt
h
s
t
u
d
ies
h
av
e
b
ee
n
co
n
d
u
cted
o
n
t
h
e
d
ev
e
lo
p
m
en
t
a
n
d
g
r
o
w
t
h
o
f
p
ed
iatr
ic,
a
d
o
lescen
t,
an
d
ad
u
lt
p
atien
ts
[
1
0
]
-
[
1
7
]
.
R
o
b
in
s
o
n
et
a
l.
co
n
d
u
cted
a
s
tu
d
y
i
n
2
0
0
7
w
i
th
t
h
e
ai
m
to
d
eter
m
in
e
w
h
et
h
er
q
u
esti
o
n
n
a
ir
es
co
u
ld
b
e
u
s
ed
to
r
e
p
lace
clin
ical
tr
ials
b
y
co
m
p
ar
i
n
g
t
h
e
d
escr
ib
ed
an
d
clin
icall
y
ex
a
m
i
n
ed
s
tat
u
s
o
f
d
en
tal
ca
r
ies
an
d
th
e
tr
ea
t
m
en
t
n
ee
d
s
in
a
s
a
m
p
le
f
r
o
m
ad
u
lts
li
v
i
n
g
i
n
E
ast
L
o
n
d
o
n
,
UK.
T
h
e
au
th
o
r
s
co
n
clu
d
e
th
a
t
s
el
f
-
ass
es
s
m
en
t
is
n
o
t
u
s
e
f
u
l
f
o
r
as
s
ess
i
n
g
a
n
d
p
lan
n
i
n
g
in
d
i
v
id
u
al
d
en
tal
ca
r
e
n
ee
d
s
.
T
h
ese
f
i
n
d
in
g
s
ar
e
u
s
e
f
u
l
f
o
r
ass
es
s
i
n
g
tr
ea
t
m
e
n
t a
n
d
d
iag
n
o
s
tic
n
ee
d
s
f
o
r
th
e
co
m
m
u
n
it
y
[
1
8
]
,
[
1
9
]
.
Di
m
o
v
a
-
Gab
r
o
v
s
k
a
a
n
d
co
-
au
th
o
r
s
co
n
d
u
cted
a
s
tu
d
y
i
n
2
0
1
9
w
i
t
h
t
h
e
ai
m
:
to
in
v
es
tig
a
te
th
e
u
s
e
o
f
lab
o
r
ato
r
y
cr
o
w
n
s
i
n
c
h
ild
r
en
u
s
ed
f
o
r
ca
s
tin
g
i
n
t
h
e
d
ail
y
p
r
ac
tice
o
f
d
en
t
is
t
s
in
B
u
l
g
ar
ia.
T
h
e
o
b
tain
ed
r
esu
lt
s
ar
e
u
s
ed
f
o
r
p
lan
n
in
g
n
e
w
cli
n
ical
an
d
tr
ea
t
m
e
n
t
g
o
als
[
2
0
]
-
[
2
6
]
.
R
esear
ch
er
s
ar
e
d
ev
elo
p
in
g
g
u
id
eli
n
e
s
f
o
r
clin
ical
ap
p
licatio
n
b
y
all
p
r
o
s
th
etic
d
en
tis
t
s
a
n
d
g
e
n
er
al
d
en
tis
tr
y
p
r
o
f
ess
io
n
als [
2
2
]
,
[
2
6
]
.
2.
RE
S
E
ARCH
M
E
T
H
O
D
T
h
e
p
u
r
p
o
s
e
o
f
th
i
s
s
t
u
d
y
is
t
o
ex
a
m
i
n
e
t
h
e
r
i
s
k
f
ac
to
r
s
a
s
s
o
ciate
d
w
it
h
t
h
e
d
ev
e
lo
p
m
en
t
o
f
d
en
tal
ca
r
ies in
ch
ild
r
en
i
n
B
u
lg
ar
ia.
2
.
1
.
M
a
t
er
ia
ls
a
nd
m
et
ho
ds
Fo
r
th
e
p
u
r
p
o
s
e
o
f
th
e
r
esear
ch
w
e
ap
p
lied
a
s
o
cio
lo
g
ical
(
s
u
r
v
e
y
)
m
et
h
o
d
.
T
h
e
r
esear
c
h
h
as
b
ee
n
ca
r
r
ied
o
u
t
at
th
e
Facu
lt
y
o
f
D
en
tal
Me
d
icin
e,
i
n
th
e
p
er
io
d
2
0
1
5
-
2
0
1
6
,
w
it
h
th
e
p
er
m
i
s
s
i
o
n
o
f
th
e
Un
i
v
er
s
i
t
y
Scien
ti
f
ic
R
e
s
ea
r
ch
C
o
m
m
i
tt
ee
an
d
i
n
f
o
r
m
ed
co
n
s
e
n
t
s
i
g
n
ed
b
y
ea
c
h
p
ar
en
t.
I
n
th
e
s
u
r
v
e
y
,
t
h
e
o
b
j
ec
t
o
f
o
b
s
er
v
atio
n
w
a
s
p
ar
en
ts
o
f
ch
ild
r
en
f
r
o
m
Var
n
a
r
eg
io
n
.
T
h
e
v
o
lu
m
e
o
f
o
b
s
er
v
ati
o
n
co
m
p
r
is
ed
1
0
0
p
ar
ticip
an
ts
.
U
n
its
o
f
o
b
s
er
v
atio
n
ar
e
p
atien
t
s
a
g
ed
th
r
ee
to
s
ix
y
ea
r
s
w
i
th
th
e
n
ee
d
f
o
r
p
r
ev
en
tio
n
an
d
tr
ea
t
m
e
n
t
o
f
d
en
tal
ca
r
ies
o
f
th
e
te
m
p
o
r
ar
y
d
e
n
titi
o
n
.
T
h
e
d
ir
ec
t
in
d
iv
id
u
al
an
o
n
y
m
o
u
s
q
u
esti
o
n
n
air
e
w
a
s
f
illed
i
n
b
y
t
h
e
p
ar
en
ts
o
f
p
ati
en
ts
i
n
d
en
ta
l
p
r
ac
tices
o
n
t
h
e
ter
r
ito
r
y
o
f
th
e
cit
y
o
f
Var
n
a
a
n
d
clin
ica
l
h
al
ls
o
f
th
e
Fac
u
lt
y
o
f
De
n
tal
Me
d
ici
n
e
-
Var
n
a.
T
h
e
r
eg
is
tr
atio
n
was
d
o
n
e
in
a
s
p
ec
iall
y
d
ev
elo
p
ed
q
u
esti
o
n
n
air
e,
in
cl
u
d
in
g
2
2
q
u
e
s
tio
n
s
,
ea
ch
w
it
h
th
e
p
o
s
s
ib
ilit
y
o
f
m
o
r
e
th
an
o
n
e
a
n
s
w
er
.
T
h
e
s
i
g
n
s
o
f
o
b
s
er
v
atio
n
ar
e:
Gen
d
er
,
ag
e,
m
ed
ical
h
i
s
to
r
y
;
C
ar
ies
d
ia
g
n
o
s
is
;
Or
al
h
y
g
ie
n
e
h
ab
its
;
Mo
ti
v
atio
n
f
o
r
p
r
ev
e
n
ti
v
e
e
x
a
m
in
at
io
n
s
an
d
n
o
n
-
i
n
v
a
s
i
v
e
tr
ea
t
m
e
n
t;
R
e
m
ed
ie
s
p
r
escr
ib
ed
b
y
a
d
en
tis
t
to
in
cr
ea
s
e
h
y
g
ien
e,
p
r
ev
en
tio
n
an
d
n
o
n
-
in
v
a
s
i
v
e
tr
ea
t
m
en
t
o
f
ca
r
ie
s
.
T
h
e
r
esu
lts
w
er
e
s
tati
s
ticall
y
p
r
o
ce
s
s
ed
w
it
h
SP
SS
v
.
2
0
.
0
,
u
s
i
n
g
v
ar
iat
io
n
a
n
d
co
m
p
ar
is
o
n
(
ch
i
-
s
q
u
ar
e)
an
al
y
ze
s
.
Fo
r
s
ig
n
i
f
ican
ce
le
v
el
w
e
ass
u
m
e
p
<0
.
0
5
.
R
esp
o
n
d
en
ts
ex
p
r
es
s
an
o
p
i
n
io
n
o
n
:
t
h
e
d
iag
n
o
s
i
s
o
f
c
ar
ies,
o
r
al
h
y
g
ien
e
h
ab
its
o
f
th
e
ch
ild
,
m
o
tiv
a
tio
n
f
o
r
p
r
ev
en
ti
v
e
e
x
a
m
in
at
io
n
s
a
n
d
n
o
n
-
in
v
as
iv
e
tr
ea
t
m
e
n
t,
to
o
ls
p
r
escr
ib
ed
b
y
t
h
e
d
en
tis
t
to
i
m
p
r
o
v
e
h
y
g
ien
e,
p
r
ev
e
n
tio
n
a
n
d
n
o
n
-
i
n
v
a
s
i
v
e
tr
ea
t
m
e
n
t o
f
c
ar
ies.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
T
h
e
r
esu
lts
s
h
o
w
t
h
at
5
%
o
f
th
e
m
o
t
h
er
s
o
f
th
e
s
t
u
d
ied
ch
il
d
r
en
h
ad
b
ad
h
ab
its
d
u
r
in
g
p
r
eg
n
a
n
c
y
.
I
n
1
0
0
%
o
f
th
e
ex
a
m
i
n
ed
m
o
th
er
s
t
h
e
p
r
eg
n
an
c
y
p
as
s
ed
w
it
h
o
u
t
co
m
p
l
icatio
n
s
a
n
d
1
0
0
%
o
f
th
e
m
d
id
n
o
t
h
av
e
an
y
d
i
s
ea
s
e
s
d
u
r
i
n
g
th
e
p
r
eg
n
an
c
y
.
O
n
l
y
3
%
o
f
t
h
e
ch
ild
r
en
s
u
r
v
e
y
ed
w
er
e
b
o
r
n
p
r
e
m
at
u
r
el
y
,
w
i
th
9
8
%
o
f
th
e
ch
i
ld
r
en
b
ein
g
b
o
r
n
w
i
th
n
o
r
m
al
w
e
ig
h
t a
n
d
2
% o
f
th
e
c
h
ild
r
en
b
ein
g
b
o
r
n
w
it
h
lo
w
weig
h
t.
In
t
h
e
Me
d
ical
h
i
s
to
r
y
o
f
th
e
s
u
r
v
e
y
ed
p
ar
en
ts
w
e
r
ec
ei
v
ed
th
e
f
o
llo
w
i
n
g
d
ata:
On
e
o
f
t
h
e
ch
ild
r
en
s
u
f
f
er
s
f
r
o
m
h
e
m
ato
lo
g
ical
d
is
ea
s
e,
o
n
e
o
f
t
h
e
c
h
ild
r
en
h
as
an
aller
g
y
to
an
tib
io
tics
f
r
o
m
th
e
g
r
o
u
p
o
f
p
en
icilli
n
s
,
o
n
e
o
f
t
h
e
ch
ild
r
en
s
u
f
f
er
s
f
r
o
m
aller
g
y
t
o
d
u
s
t
a
n
d
m
ite
s
,
t
w
o
o
f
t
h
e
ch
ild
r
en
s
u
f
f
er
f
r
o
m
al
ler
g
ic
r
h
in
i
tis
,
o
n
e
o
f
t
h
e
c
h
ild
r
en
s
u
f
f
er
s
f
r
o
m
k
id
n
e
y
d
is
ea
s
e,
a
n
d
o
n
e
o
f
t
h
e
ch
ild
r
en
i
s
tr
ea
t
ed
w
it
h
th
e
d
r
u
g
:
L
-
T
h
y
r
o
x
i
n
e.
T
h
e
r
esu
lts
s
h
o
w
t
h
at
p
ar
en
ts
ar
e
a
w
ar
e
o
f
t
h
e
n
ee
d
f
o
r
p
r
ev
en
t
iv
e
e
x
a
m
i
n
atio
n
s
o
f
c
h
il
d
r
en
ag
ed
th
r
ee
to
s
ix
y
ea
r
s
.
Alt
h
o
u
g
h
6
9
%
o
f
t
h
e
p
ar
en
t
s
s
ta
te
t
h
at
th
e
v
i
s
it
to
t
h
e
d
e
n
ti
s
t
i
s
co
n
s
ec
u
ti
v
e
a
n
d
th
e
y
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N:
2
2
5
2
-
8
8
0
6
I
n
t.
J
.
P
u
b
lic
Hea
lth
Sci.
,
Vo
l.
1
0
,
No
.
2
,
J
u
n
e
20
21
:
2
5
8
–
2
6
4
260
r
eg
u
lar
l
y
o
b
s
er
v
e
t
h
e
p
r
o
p
h
y
l
ac
tic
ex
a
m
i
n
atio
n
s
o
f
th
eir
c
h
ild
r
en
,
3
1
%
in
d
icate
t
h
at
t
h
e
y
h
av
e
n
o
t
ta
k
e
n
t
h
e
ch
ild
f
o
r
a
p
r
o
p
h
y
lactic
d
e
n
ta
l
ex
a
m
i
n
atio
n
y
et
at
t
h
e
a
g
e
o
f
t
h
r
ee
.
Den
tal
p
r
ac
tices
ar
e
atten
d
ed
b
y
8
%
o
f
ch
ild
r
en
f
o
r
ex
a
m
i
n
atio
n
i
n
o
n
e
m
o
n
th
,
an
d
2
0
%
in
th
r
ee
m
o
n
t
h
s
.
T
h
e
h
ig
h
e
s
t
p
er
ce
n
tag
e
o
f
p
ar
en
ts
-
7
2
%
v
is
i
t
a
d
en
tal
o
f
f
ice
f
o
r
p
r
ev
en
tio
n
a
n
d
tr
ea
t
m
e
n
t
o
f
t
h
eir
c
h
ild
r
en
e
v
er
y
s
ix
m
o
n
t
h
s
,
o
r
tw
o
ti
m
es
a
y
ea
r
.
On
th
e
o
n
e
h
an
d
,
t
h
ese
r
es
u
lt
s
m
a
y
b
e
r
elate
d
to
th
e
p
r
ac
tices
in
th
e
cit
y
o
f
Var
n
a,
w
h
ic
h
h
av
e
co
n
tr
ac
ts
w
it
h
t
h
e
Natio
n
al
Hea
lt
h
I
n
s
u
r
a
n
ce
F
u
n
d
,
b
u
t
o
n
th
e
o
t
h
er
h
a
n
d
s
h
o
w
s
t
h
at
a
h
ig
h
er
p
er
ce
n
tag
e
o
f
ch
il
d
r
en
i
n
t
h
e
s
u
r
v
e
y
ar
e
at
h
i
g
h
r
is
k
o
f
d
en
t
al
ca
r
ies.
R
eg
ar
d
in
g
q
u
esti
o
n
№
1
3
“Do
y
o
u
h
av
e
d
if
f
ic
u
ltie
s
i
n
r
ec
o
g
n
izi
n
g
y
o
u
r
ch
i
ld
's
d
en
ta
l
ca
r
ies?
,
”
p
ar
en
ts
o
p
en
l
y
s
h
ar
e
th
e
d
i
f
f
i
cu
ltie
s
w
it
h
th
e
d
iag
n
o
s
is
-
D
en
tal
ca
r
ie
s
o
f
te
m
p
o
r
ar
y
teet
h
,
as
5
4
.
0
%
o
f
t
h
e
m
d
o
n
o
t
r
ec
o
g
n
ize
a
n
d
d
o
n
o
t
h
av
e
th
e
n
ec
es
s
ar
y
k
n
o
w
led
g
e
ab
o
u
t
th
e
d
ia
g
n
o
s
is
.
4
6
.
0
%
o
f
t
h
e
r
esp
o
n
d
en
t
s
d
ec
lar
e
k
n
o
w
led
g
e
a
n
d
ex
p
er
ien
ce
in
d
ia
g
n
o
s
in
g
ca
r
ies o
f
te
m
p
o
r
ar
y
teet
h
as
s
h
o
w
n
Fi
g
u
r
e
1
.
Fro
m
q
u
e
s
tio
n
№1
4
"
Do
es
y
o
u
r
ch
ild
h
a
v
e
d
en
tal
ca
r
ies?
"
,
a
v
er
y
h
ig
h
p
er
ce
n
tag
e
o
f
p
ar
en
ts
r
ep
o
r
t
ch
ild
d
en
tal
ca
r
ies
d
is
ea
s
e
o
f
th
e
te
m
p
o
r
ar
y
teet
h
-
7
5
.
0
%
an
d
o
n
l
y
2
5
.
0
%
o
f
c
h
ild
r
en
d
o
n
o
t
g
e
t
s
ick
as
s
h
o
w
n
Fi
g
u
r
e
2
.
Fig
u
r
e
1
.
Do
y
o
u
h
a
v
e
d
if
f
ic
u
l
t
y
d
iag
n
o
s
i
n
g
y
o
u
r
ch
ild
'
s
d
en
ta
l c
ar
ies?
Fig
u
r
e
2
.
Do
es
y
o
u
r
ch
ild
h
av
e
d
en
tal
ca
r
ies?
P
ar
en
ts
w
h
o
h
a
v
e
alr
ea
d
y
h
ad
ca
s
es
o
f
d
en
tal
ca
r
ies
in
ch
i
ld
r
en
r
ec
o
g
n
ize
t
h
e
s
y
m
p
to
m
s
m
u
c
h
m
o
r
e
ea
s
il
y
t
h
an
t
h
o
s
e
w
h
o
en
co
u
n
t
er
th
e
p
r
o
b
lem
f
o
r
th
e
f
ir
s
t
ti
m
e
(
p
<0
.
0
5
)
.
T
o
q
u
esti
o
n
№
1
5
,
“
Has
y
o
u
r
ch
ild
h
ad
i
n
j
u
r
ies?
,
”
3
%
o
f
p
ar
en
ts
r
ep
o
r
ted
in
j
u
r
ies
to
t
h
eir
ch
ild
r
en
's
tee
th
,
3
%
o
f
ch
ild
r
en
h
a
d
f
ac
ial
in
j
u
r
ies
a
n
d
3
% h
ad
o
r
al
an
d
/o
r
d
en
tal
in
j
u
r
ies
as s
h
o
w
n
Fi
g
u
r
e
3
.
Fig
u
r
e
3
.
Has
y
o
u
r
ch
ild
h
ad
i
n
j
u
r
ies?
T
o
q
u
esti
o
n
№
1
6
ab
o
u
t
t
h
e
m
o
tiv
a
tio
n
o
f
c
h
ild
r
en
a
n
d
th
eir
b
eh
av
io
r
i
n
a
f
ea
r
f
u
l
clin
ica
l
en
v
ir
o
n
m
e
n
t,
t
h
e
r
esp
o
n
d
en
ts
s
h
o
w
ed
k
n
o
w
led
g
e
o
f
m
o
t
iv
at
in
g
c
h
ild
r
en
-
8
1
%
o
f
ch
ild
r
en
d
o
n
o
t
h
av
e
f
ea
r
f
u
l
b
eh
av
io
r
,
1
3
%
h
av
e
li
ttle
f
e
ar
an
d
6
%
o
f
p
ar
en
ts
an
d
c
h
ild
r
en
h
av
e
p
r
o
b
le
m
s
atte
n
d
i
n
g
p
r
ev
e
n
tio
n
an
d
tr
ea
t
m
e
n
t in
d
e
n
tal
cli
n
ics a
n
d
p
r
ac
tices
as sh
o
w
n
Fi
g
u
r
e
4
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t.
J
.
P
u
b
lic
Hea
lth
Sci.
I
SS
N:
2
2
5
2
-
8806
R
is
k
fa
cto
r
s
a
s
s
o
cia
ted
w
ith
th
e
d
ev
elo
p
men
t
o
f d
en
ta
l c
a
r
ies in
…
(
Do
b
r
in
k
a
Da
mya
n
o
v
a
)
261
Fig
u
r
e
4
.
I
s
y
o
u
r
ch
ild
a
f
r
aid
o
f
d
en
tal
tr
ea
t
m
e
n
t?
Qu
est
io
n
№
1
7
“
Do
es
th
e
c
h
i
ld
h
av
e
b
ad
h
ab
it
s
,
”
1
%
o
f
th
e
p
ar
en
ts
r
ep
o
r
t
th
e
h
ab
it
o
f
s
u
ck
i
n
g
lip
s
an
d
ch
ee
k
s
,
1
1
%
o
f
t
h
e
h
ab
it
o
f
b
itin
g
n
ail
s
b
y
ch
i
ld
r
en
,
6
%
g
n
as
h
t
h
eir
tee
th
,
4
%
o
f
c
h
ild
r
en
h
a
v
e
t
h
e
h
ab
it
o
f
s
u
ck
i
n
g
th
e
ir
th
u
m
b
(
s
)
,
an
d
1
%
o
f
ch
ild
r
en
f
all
aslee
p
at
th
is
a
g
e
w
it
h
a
b
o
ttle
o
f
m
i
lk
/j
u
ice.
I
t
i
s
n
o
te
w
o
r
t
h
y
t
h
at
n
o
n
e
o
f
t
h
e
r
esp
o
n
d
en
ts
in
d
icate
d
t
h
e
h
ar
m
f
u
l
h
ab
it
o
f
s
u
c
k
in
g
a
p
ac
if
ier
b
y
th
e
ch
i
ld
.
P
r
o
b
ab
ly
b
y
th
e
a
g
e
o
f
th
r
ee
p
ar
en
ts
h
a
v
e
en
o
u
g
h
k
n
o
w
led
g
e
an
d
s
k
ills
a
n
d
th
e
u
s
e
o
f
a
p
ac
if
ier
s
to
p
s
m
u
ch
ea
r
lier
th
an
t
h
e
ag
e
w
e
s
tu
d
ied
.
T
h
e
m
o
s
t
p
o
p
u
lar
is
th
e
d
o
u
b
l
e
b
r
u
s
h
in
g
o
f
teet
h
b
y
c
h
ild
r
e
n
(
5
4
%
o
f
t
h
e
s
u
r
v
e
y
ed
p
ar
en
t
s
)
,
1
7
%
o
f
ch
ild
r
en
b
r
u
s
h
th
e
m
o
n
ce
a
d
a
y
,
3
%
o
f
c
h
ild
r
en
t
h
r
ee
ti
m
e
s
a
d
a
y
,
2
%
r
ar
el
y
d
u
r
in
g
t
h
e
w
ee
k
a
n
d
2
%
o
f
ch
ild
r
en
b
r
u
s
h
t
h
eir
teeth
t
h
eir
w
h
en
t
h
e
y
r
e
m
e
m
b
er
d
u
r
i
n
g
t
h
e
d
a
y
as s
h
w
o
n
Fi
g
u
r
e
5
.
Fig
u
r
e
5
.
Ho
w
m
a
n
y
ti
m
es a
d
a
y
d
o
es
y
o
u
r
ch
ild
b
r
u
s
h
h
is
te
eth
?
A
t
t
h
e
s
a
m
e
ti
m
e,
9
0
%
o
f
ch
il
d
r
en
u
s
e
f
l
u
o
r
id
e
to
o
th
p
aste,
2
7
%
o
f
ch
ild
r
en
ag
ed
th
r
ee
to
s
ix
u
s
e
lo
w
m
i
n
er
al
w
ater
f
o
r
d
r
in
k
i
n
g
f
l
u
o
r
id
e.
On
l
y
3
%
o
f
ch
i
ld
r
en
to
o
k
f
l
u
o
r
id
e
co
n
tain
i
n
g
tab
lets
,
an
d
f
l
u
o
r
id
e
g
els
w
er
e
n
o
t
u
s
ed
b
y
r
esp
o
n
d
e
n
t
s
at
h
o
m
e.
T
o
q
u
esti
o
n
№
2
0
.
1
,
“
Do
es
y
o
u
r
c
h
ild
u
s
e
m
o
u
th
w
as
h
an
d
d
en
tal
f
lo
s
s
?
,
”
k
n
o
w
led
g
e
o
f
w
ater
f
o
r
o
r
al
h
y
g
ie
n
e,
as
w
ell
a
s
th
e
ir
ap
p
licatio
n
w
a
s
d
e
m
o
n
s
tr
at
ed
b
y
6
%
o
f
p
ar
en
t
s
o
f
ch
i
ld
r
en
o
v
er
s
i
x
y
ea
r
s
.
De
n
tal
f
lo
s
s
is
u
s
ed
b
y
1
0
%
o
f
c
h
ild
r
en
a
g
ed
th
r
ee
to
s
ix
y
ea
r
s
,
ac
co
r
d
in
g
to
th
e
ir
p
ar
en
ts
.
Fro
m
th
e
o
b
tain
ed
r
es
u
lts
w
e
ca
n
co
n
clu
d
e
t
h
at
th
e
m
o
s
t
co
m
m
o
n
o
f
th
e
m
ea
n
s
f
o
r
p
e
r
s
o
n
al
o
r
al
h
y
g
ie
n
e
o
f
c
h
ild
r
en
a
g
ed
t
h
r
ee
to
s
ix
y
ea
r
s
i
s
to
o
th
p
aste
s
f
o
r
ch
ild
r
en
w
ith
f
l
u
o
r
id
e
co
n
ce
n
tr
atio
n
f
o
r
t
h
e
s
tu
d
ied
a
g
e.
O
n
t
h
e
o
t
h
er
h
a
n
d
o
n
q
u
esti
o
n
№
2
1
,
“
Ha
s
an
y
p
r
o
p
h
y
lactic
to
o
th
p
aste
b
ee
n
ap
p
lied
to
y
o
u
r
ch
ild
'
s
teeth
i
n
t
h
e
d
e
n
tal
o
f
f
ice?
On
l
y
1
0
%
o
f
t
h
e
s
u
r
v
e
y
ed
p
ar
en
ts
r
ep
o
r
t
p
r
ev
en
tio
n
a
n
d
n
o
n
-
in
v
as
iv
e
tr
ea
t
m
e
n
t
o
f
th
eir
ch
ild
r
en
Fi
g
u
r
e
6
an
d
1
0
%
o
f
th
e
m
f
o
r
th
e
ap
p
licatio
n
o
f
p
r
o
p
h
y
lac
tic
p
astes
b
y
th
eir
ch
ild
r
en
at
h
o
m
e
as
s
h
o
w
n
Fi
g
u
r
e
6
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N:
2
2
5
2
-
8
8
0
6
I
n
t.
J
.
P
u
b
lic
Hea
lth
Sci.
,
Vo
l.
1
0
,
No
.
2
,
J
u
n
e
20
21
:
2
5
8
–
2
6
4
262
Fig
u
r
e
6
.
Has a
n
y
p
r
o
p
h
y
lacti
c
to
o
th
p
aste b
ee
n
ap
p
lied
to
y
o
u
r
ch
ild
'
s
teet
h
in
t
h
e
d
e
n
ta
l o
f
f
ice?
Of
t
h
e
m
ea
n
s
f
o
r
r
e
m
i
n
er
ali
za
tio
n
an
d
n
o
n
-
i
n
v
a
s
i
v
e
tr
ea
t
m
en
t
o
f
ea
r
l
y
e
n
a
m
el
lesi
o
n
s
at
h
o
m
e,
r
esp
o
n
d
en
ts
ap
p
l
y
G
C
T
o
o
th
Mo
u
s
s
e
9
%
[
T
o
o
th
Mo
u
s
s
e
-
B
io
-
a
v
ailab
le
ca
lci
u
m
a
n
d
p
h
o
s
p
h
ate,
w
it
h
o
u
t
f
l
u
o
r
id
e,
GC
]
[
2
7
]
.
Fo
r
th
i
s
r
ea
s
o
n
,
t
h
er
e
i
s
a
n
ee
d
f
o
r
a
n
e
w
ap
p
r
o
ac
h
a
n
d
p
r
ac
tice
o
f
p
ed
iatr
ic
d
e
n
tis
t
s
,
o
r
ien
ted
in
p
r
ac
tice,
m
ee
ti
n
g
th
e
e
x
p
ec
tatio
n
s
o
f
p
ar
en
ts
to
m
o
r
e
p
r
ev
e
n
ti
v
e
a
n
d
n
o
n
-
i
n
v
asi
v
e
m
et
h
o
d
s
o
f
tr
ea
t
m
e
n
t o
f
d
en
tal
ca
r
ie
s
o
f
te
m
p
o
r
ar
y
d
en
titi
o
n
.
I
n
p
r
o
ce
s
s
in
g
th
e
f
o
llo
w
i
n
g
d
ata,
Stu
d
en
t
'
s
cr
iter
io
n
w
a
s
u
s
ed
to
co
m
p
ar
e
th
e
m
ea
n
v
al
u
es
o
f
t
w
o
in
d
ep
en
d
en
t
s
a
m
p
les.
I
n
a
co
m
p
ar
at
iv
e
an
al
y
s
is
o
f
q
u
esti
o
n
s
“A
v
is
i
t
to
t
h
e
d
e
n
tis
t?
”
An
d
“
d
o
es
y
o
u
r
c
h
ild
tak
e
f
l
u
o
r
id
e
in
v
ar
io
u
s
f
o
r
m
s
?
”
We
f
o
u
n
d
th
a
t
7
1
.
0
1
%
o
f
c
h
ild
r
en
a
g
ed
t
h
r
ee
to
s
i
x
y
ea
r
s
v
is
it
a
d
en
tis
t,
a
n
d
p
atien
ts
u
s
e
f
l
u
o
r
id
e
o
n
l
y
in
t
h
e
f
o
r
m
o
f
to
o
th
p
aste
co
n
tai
n
i
n
g
f
lu
o
r
id
e.
On
th
e
o
th
er
h
a
n
d
,
th
is
r
esu
lt
p
r
o
v
es
th
e
o
b
s
er
v
a
n
ce
o
f
g
o
o
d
o
r
al
h
y
g
ie
n
e
an
d
k
n
o
w
led
g
e
o
f
c
h
il
d
r
en
's
to
o
th
p
as
tes
w
it
h
d
i
f
f
er
e
n
t
co
n
ce
n
tr
atio
n
s
o
f
f
l
u
o
r
id
e
an
d
i
n
s
u
f
f
icie
n
t
k
n
o
w
led
g
e
an
d
ap
p
licatio
n
b
y
p
a
r
en
ts
a
n
d
ch
ild
r
e
n
o
f
d
en
tal
f
lo
s
s
(
9
0
%)
an
d
o
r
al
h
y
g
ie
n
e
w
a
ter
(
9
4
%)
b
y
s
ix
-
y
ea
r
-
o
ld
s
.
P
r
o
b
ab
ly
t
h
e
w
id
e
k
n
o
w
led
g
e
o
f
c
h
ild
r
en
's
p
aste
s
f
o
r
o
r
al
h
y
g
ien
e
is
d
u
e
to
ad
v
er
tis
in
g
a
n
d
th
e
m
e
d
ia,
g
iv
i
n
g
co
n
s
ta
n
t i
n
f
o
r
m
ati
o
n
to
p
ar
en
ts
.
I
n
a
co
m
p
ar
ativ
e
a
n
al
y
s
is
o
f
“
q
u
e
s
tio
n
s
w
as
t
h
er
e
an
y
ap
p
licatio
n
o
f
p
r
o
p
h
y
lact
ic
p
aste
s
o
n
y
o
u
r
ch
ild
'
s
teet
h
i
n
t
h
e
d
en
tal
o
f
f
ice?
”
A
n
d
“
d
o
es
y
o
u
r
c
h
ild
t
ak
e
f
lu
o
r
id
e
in
v
ar
io
u
s
f
o
r
m
s
?
”
We
f
o
u
n
d
th
at
7
1
.
8
4
%
o
f
ch
ild
r
en
ag
ed
th
r
e
e
to
s
ix
y
ea
r
s
u
s
e
o
n
l
y
f
l
u
o
r
i
d
e
to
o
th
p
aste.
T
h
is
s
h
o
w
s
th
e
ig
n
o
r
an
ce
o
f
t
h
e
p
ar
en
ts
an
d
th
e
i
n
s
u
f
f
ic
ien
t
ap
p
licatio
n
b
y
d
en
tis
t
s
o
f
th
e
p
r
e
v
en
t
iv
e
a
n
d
n
o
n
-
o
p
er
ativ
e
tr
ea
t
m
e
n
t
o
f
th
e
i
n
itial
ca
r
ies
i
n
t
h
e
d
en
tal
p
r
ac
tices
f
o
r
th
e
te
m
p
o
r
ar
y
d
en
ti
tio
n
.
9
0
%
o
f
th
e
r
e
s
p
o
n
d
en
t
s
d
id
n
o
t
ap
p
ly
p
r
o
p
h
y
lactic
p
astes
o
n
t
h
e
ch
ild
'
s
tee
th
,
b
o
th
in
t
h
e
d
en
tal
o
f
f
ice
an
d
at
h
o
m
e.
3
.
1
.
Dis
cu
s
s
io
n
Den
tal
ca
r
ies
d
u
r
i
n
g
ea
r
l
y
c
h
i
ld
h
o
o
d
is
a
m
u
lti
f
ac
to
r
ial
d
is
ea
s
e.
E
ar
ly
c
h
ild
h
o
o
d
ca
r
ies
(
E
C
C
)
is
a
ter
m
u
s
ed
to
d
escr
ib
e
d
en
tal
ca
r
ies
in
th
e
p
r
i
m
ar
y
d
en
tit
io
n
o
f
y
o
u
n
g
ch
i
ld
r
en
[
2
8
]
.
T
h
e
p
r
esen
ce
o
f
o
n
e
o
r
m
o
r
e
d
ec
a
y
ed
th
at
ca
n
b
e
n
o
n
-
ca
v
ita
ted
o
r
ca
v
itated
,
m
is
s
in
g
d
u
e
to
ca
r
ies,
o
r
f
illed
to
o
th
s
u
r
f
ac
es
in
a
n
y
p
r
im
ar
y
to
o
t
h
i
n
a
ch
ild
.
De
n
tal
ca
r
ies
ar
e
ca
u
s
ed
b
y
t
h
e
i
n
ter
ac
tio
n
b
e
t
w
ee
n
t
h
e
b
ac
ter
ia
w
h
ich
p
r
o
d
u
ce
s
ac
id
,
th
e
ca
r
b
o
h
y
d
r
ate
s
u
b
s
tr
ate
(
f
r
eq
u
en
tl
y
s
u
cr
o
s
e)
a
n
d
th
e
h
o
s
ts
s
u
s
ce
p
tib
ilit
y
[
2
9
]
.
T
h
e
p
r
im
ar
y
p
ath
o
g
e
n
r
ec
o
g
n
is
ed
f
o
r
E
C
C
is
S
tr
ep
to
co
cc
u
s
Mu
ta
n
s
.
Alo
n
g
w
it
h
S.
m
u
ta
n
s
E
C
C
al
s
o
r
ep
o
r
ts
s
ig
n
i
f
ican
t
ass
o
ciatio
n
w
it
h
S
.
p
ar
asa
n
g
u
i
n
is
,
S.
s
a
liv
ar
iu
s
,
L
ac
to
b
ac
illu
s
ca
s
ei
an
d
A
cti
n
o
m
y
ce
s
v
i
s
co
s
u
s
[
3
0
]
.
P
r
ev
en
tio
n
:
C
es
s
atio
n
o
f
h
ab
it
;
Dietar
y
ad
v
ice
[
3
1
]
;
p
o
s
s
ib
le
u
s
e
o
f
a
n
ti
m
icr
o
b
ial
p
r
o
d
u
cts;
Flu
o
r
id
e
ap
p
licatio
n
[
3
2
]
.
I
n
f
an
t
s
h
o
u
l
d
n
o
t
b
e
p
u
t
to
s
leep
w
it
h
a
b
o
ttle
(
in
f
a
n
t
s
h
o
u
ld
b
e
en
co
u
r
ag
ed
to
d
r
in
k
f
r
o
m
cu
p
)
;
E
li
m
i
n
atio
n
o
f
a
b
o
ttle
h
ab
it
ca
n
b
e
ac
h
iev
ed
b
y
g
r
ad
u
all
y
r
ed
u
ci
n
g
t
h
e
a
m
o
u
n
t
o
f
s
u
g
ar
in
t
h
e
b
o
ttle
b
y
d
ilu
ti
n
g
w
it
h
w
a
ter
.
T
h
is
ca
n
b
e
d
o
n
e
o
v
er
s
e
v
er
al
w
ee
k
s
.
Alter
n
ati
v
el
y
,
s
o
m
e
p
ar
en
t
s
f
i
n
d
it e
a
s
ier
to
r
e
m
o
v
e
th
e
b
o
ttle i
m
m
ed
iatel
y
[
3
3
]
.
4.
CO
NCLU
SI
O
N
B
ased
o
n
th
e
d
ata
o
b
tain
ed
f
r
o
m
t
h
e
s
u
r
v
e
y
a
m
o
n
g
p
atie
n
t
s
f
r
o
m
t
h
e
cit
y
o
f
Var
n
a
an
d
Var
n
a
r
eg
io
n
,
th
e
f
o
llo
w
in
g
co
n
cl
u
s
io
n
s
ca
n
b
e
m
ad
e:
T
h
e
s
u
r
v
e
y
ed
p
ar
en
ts
o
f
c
h
ild
r
en
a
g
ed
t
h
r
ee
to
s
i
x
y
ea
r
s
h
av
e
s
atis
f
ac
to
r
y
k
n
o
w
led
g
e
a
n
d
h
ab
its
r
eg
ar
d
in
g
a
n
u
m
b
er
o
f
r
is
k
f
ac
to
r
s
f
o
r
th
e
d
ev
elo
p
m
e
n
t
o
f
d
en
tal
ca
r
ies,
co
n
ce
r
n
i
n
g
t
h
e
o
r
al
h
ea
lth
o
f
th
eir
ch
ild
r
en
a
n
d
th
e
m
ai
n
te
n
an
ce
o
f
o
r
al
h
y
g
ie
n
e.
No
s
ig
n
i
f
ica
n
t
d
if
f
er
en
c
e
w
a
s
f
o
u
n
d
b
et
w
ee
n
t
h
e
r
esp
o
n
d
en
t
s
i
n
ter
m
s
o
f
f
o
r
m
in
g
a
n
o
p
in
io
n
a
n
d
b
eh
a
v
io
r
o
n
k
e
y
i
s
s
u
es
r
ela
ted
to
p
r
ev
en
tio
n
,
o
r
al
h
y
g
ie
n
e
a
n
d
p
r
ev
en
ti
v
e
a
n
d
n
o
n
-
in
v
a
s
iv
e
tr
ea
t
m
e
n
t
o
f
ca
r
ies
o
f
te
m
p
o
r
ar
y
teeth
.
T
h
e
n
u
m
b
er
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t.
J
.
P
u
b
lic
Hea
lth
Sci.
I
SS
N:
2
2
5
2
-
8806
R
is
k
fa
cto
r
s
a
s
s
o
cia
ted
w
ith
th
e
d
ev
elo
p
men
t
o
f d
en
ta
l c
a
r
ies in
…
(
Do
b
r
in
k
a
Da
mya
n
o
v
a
)
263
an
d
t
y
p
e
o
f
v
is
i
ts
to
th
e
d
e
n
tal
clin
ic
-
p
r
i
m
ar
il
y
o
r
co
n
s
ec
u
ti
v
el
y
ar
e
n
o
t
f
ac
to
r
s
f
o
r
ch
a
n
g
e
in
t
h
e
m
et
h
o
d
s
an
d
m
ea
n
s
o
f
o
r
al
h
y
g
ie
n
e
a
n
d
p
r
ev
en
t
iv
e
a
n
d
n
o
n
-
in
v
as
iv
e
tr
e
at
m
e
n
t
o
f
p
atie
n
t
s
.
A
s
t
u
d
y
o
f
th
e
k
n
o
w
led
g
e
an
d
b
eh
av
io
r
o
f
p
ar
en
t
s
ai
m
ed
at
th
e
d
ir
ec
tio
n
o
f
r
i
s
k
f
ac
to
r
s
f
o
r
d
en
tal
ca
r
ies
an
d
o
r
al
p
r
ev
en
tio
n
r
e
v
ea
led
th
e
n
ee
d
f
o
r
a
n
e
w
ap
p
r
o
ac
h
o
f
p
ed
iatr
ic
d
e
n
tis
t
s
,
f
o
cu
s
ed
o
n
p
r
o
g
r
a
m
m
i
n
g
p
r
ev
e
n
ti
v
e
an
d
n
o
n
-
i
n
v
asi
v
e
tr
ea
t
m
e
n
t
o
f
c
h
ild
r
en
ac
co
r
d
in
g
to
t
h
eir
in
d
i
v
id
u
a
l
n
ee
d
s
.
I
f
t
h
er
e
ar
e
in
cip
ie
n
t/
w
h
ite
s
p
o
t
l
esio
n
s
p
r
ese
n
t
t
h
e
n
th
e
tr
ea
t
m
e
n
t
s
h
o
u
ld
p
r
o
ce
ed
w
it
h
p
r
ev
en
tativ
e
tr
ea
t
m
en
t.
T
h
is
in
c
lu
d
es
f
lu
o
r
id
e
ap
p
lica
tio
n
,
f
is
s
u
r
e
s
ea
la
n
t
ap
p
licatio
n
,
an
d
e
x
p
la
n
atio
n
o
f
ca
u
s
es
w
it
h
o
u
t
as
s
i
g
n
in
g
b
la
m
e,
ed
u
ca
tio
n
an
d
ad
v
ice
t
o
th
e
p
ar
e
n
ts
ab
o
u
t
ce
s
s
atio
n
o
f
th
e
b
ad
h
ab
it
s
ca
u
s
i
n
g
ca
r
ies
,
d
ietar
y
ad
v
ic
e,
o
r
al
h
y
g
ie
n
e
i
n
s
tr
u
ctio
n
a
n
d
to
o
th
b
r
u
s
h
in
g
in
s
tr
u
ctio
n
.
ACK
NO
WL
E
D
G
E
M
E
NT
S
T
h
e
au
th
o
r
s
w
o
u
ld
lik
e
to
t
h
a
n
k
Ass
o
c.
P
r
o
f
.
Dr
.
A
s
s
ia
Kr
a
s
tev
a
-
P
an
o
v
a
f
o
r
th
e
s
u
p
p
o
r
t
co
n
ce
r
n
i
n
g
p
r
ep
ar
atio
n
o
f
th
e
in
q
u
ir
y
f
o
r
m
s
an
d
A
s
s
o
c.
P
r
o
f
.
E
m
a
n
u
el
a
Mo
u
taf
o
v
a
w
h
o
co
n
tr
ib
u
ted
to
th
e
p
er
f
o
r
m
an
ce
o
f
th
e
s
ta
ti
s
t
ical
an
al
y
s
is
.
RE
F
E
R
E
NC
E
S
[1
]
F
re
n
c
k
e
n
,
J.E
e
t
a
l.
,
“
M
in
im
a
l
in
terv
e
n
ti
o
n
d
e
n
ti
stry
f
o
r
m
a
n
a
g
in
g
d
e
n
tal
c
a
ries
-
a
r
e
v
ie
w
:
Re
p
o
rt
o
f
F
DI
tas
k
g
ro
u
p
,
”
I
n
ter
n
a
ti
o
n
a
l
De
n
ta
l
J
o
u
r
n
a
l
,
v
o
l.
62
,
n
o
.
5
,
p
p
.
2
2
3
-
4
3
,
2
0
1
2
,
d
o
i:
1
0
.
1
1
1
1
/
id
j
.
1
2
0
0
7
.
[2
]
Bre
a
k
e
r,
R.
R.
,
“
N
e
w
in
sig
h
t
o
n
th
e
re
sp
o
n
se
o
f
b
a
c
teria
to
f
lu
o
ri
d
e
,
”
Ca
rie
s
Res
e
a
rc
h
,
v
o
l.
4
6
,
n
o
.
1
,
p
p
.
78
-
8
1
,
2
0
1
2
,
d
o
i:
1
0
.
1
1
5
9
/
0
0
0
3
3
6
3
9
7
.
[3
]
D
a
m
y
a
n
o
v
a
,
D
e
t
a
l.
,
“
T
re
a
t
m
e
n
t
a
f
ter
il
ln
e
ss
o
f
e
a
rl
y
c
h
il
d
h
o
o
d
c
a
ries
-
c
li
n
ica
l
c
a
se
re
p
o
rt
,
"
Qu
e
st
J
o
u
rn
a
l
s
J
o
u
rn
a
l
o
f
M
e
d
ica
l
a
n
d
De
n
t
a
l
S
c
ien
c
e
Res
e
a
rc
h
,
v
o
l.
4
,
n
o
.
5
,
p
p
.
79
-
8
2
,
2
0
1
7
.
[4
]
Ra
m
o
s
-
G
o
m
e
z
,
F
r.
J
e
t
a
l.
,
“
P
e
d
iatric
d
e
n
tal
c
a
re
:
p
re
v
e
n
ti
o
n
a
n
d
m
a
n
a
g
e
m
e
n
t
p
ro
to
c
o
ls
b
a
se
d
o
n
c
a
ries
risk
a
ss
e
ss
m
e
n
t
,
”
J
o
u
rn
a
l
Ca
l
if
o
r
n
ia
De
n
t
al
Asso
c
i
a
ti
o
n
,
v
o
l.
38
,
n
o
.
10
,
p
p
.
7
4
6
-
7
6
1
,
2
0
1
0
.
[5
]
S
h
in
,
Hy
e
-
S
u
n
e
t
a
l.
,
“
Ko
re
a
n
v
e
rsio
n
o
f
c
h
il
d
p
e
rc
e
p
ti
o
n
s
q
u
e
sti
o
n
n
a
ire
a
n
d
d
e
n
tal
c
a
ries
a
m
o
n
g
k
o
re
a
n
c
h
il
d
re
n
,
”
PL
o
S
On
e
,
v
o
l
.
1
0
,
n
o
.
2
,
2
0
1
5
.
d
o
i:
1
0
.
1
3
7
1
/
jo
u
rn
a
l.
p
o
n
e
.
0
1
1
6
0
1
1
2
0
1
5
.
[6
]
S
u
m
a
S
o
g
,
H.
P
e
t
a
l.
,
“
Kn
o
w
le
d
g
e
,
a
tt
it
u
d
e
,
a
n
d
p
ra
c
ti
c
e
s
o
f
o
ra
l
h
e
a
lt
h
c
a
re
in
p
re
v
e
n
ti
o
n
o
f
e
a
rl
y
c
h
il
d
h
o
o
d
c
a
ries
a
m
o
n
g
p
a
re
n
ts
o
f
c
h
il
d
re
n
in
Be
lag
a
v
i
c
it
y
:
A
q
u
e
stio
n
n
a
ire stu
d
y
,
”
J
o
u
rn
a
l
Fa
mily
M
e
d
icin
e
Prima
ry
Ca
re
,
v
o
l.
5
,
n
o
.
2
,
p
p
.
2
8
6
-
2
9
0
,
2
0
1
6
,
d
o
i:
1
0
.
4
1
0
3
/
2
2
4
9
-
4
8
6
3
.
1
9
2
3
3
2
[7
]
A
i
m
é
e
,
N.R.
,
Da
m
é
-
T
.
N.,
“
Re
sp
o
n
siv
e
n
e
ss
o
f
o
ra
l
h
e
a
lt
h
-
re
late
d
q
u
a
li
ty
o
f
li
f
e
q
u
e
stio
n
n
a
ires
to
d
e
n
tal
c
a
ries
in
terv
e
n
ti
o
n
s:
S
y
ste
m
a
ti
c
r
e
v
ie
w
a
n
d
m
e
ta
-
a
n
a
l
y
sis,”
Ca
rie
s
Res
e
a
rc
h
,
v
o
l.
53
,
n
o
.
6
,
p
p
.
5
8
5
-
5
9
8
,
2
0
1
9
,
d
o
i:
1
0
.
1
1
5
9
/
0
0
0
5
0
0
8
5
5
.
[8
]
V
il
lal
o
b
o
s
-
G
a
lv
is,
F
.
H.,
a
n
d
M
a
f
la,
A
.
C.
,
“
P
sy
c
h
o
m
e
tri
c
p
ro
p
e
rti
e
s
o
f
th
e
r
e
v
ise
d
il
ln
e
ss
p
e
rc
e
p
ti
o
n
q
u
e
stio
n
n
a
ire f
o
r
o
ra
l
h
e
a
lt
h
,
”
Ca
rie
s
Res
e
a
rc
h
,
v
o
l.
51
,
n
o
.
3
,
p
p
.
244
-
2
5
4
.
2
0
1
7
,
d
o
i:
1
0
.
1
1
5
9
/0
0
0
4
6
8
9
9
3
.
[9
]
M
o
y
sé
s
,
J.
S
.
,
“
In
e
q
u
a
li
ti
e
s
in
o
ra
l
h
e
a
lt
h
a
n
d
o
ra
l
h
e
a
lt
h
p
r
o
m
o
ti
o
n
,
”
Br
a
zili
a
n
Or
a
l
Res
e
a
rc
h
,
v
o
l.
26
,
2
0
1
2
,
h
tt
p
s:/
/d
o
i.
o
rg
/1
0
.
1
5
9
0
/S
1
8
0
6
-
8
3
2
4
2
0
1
2
0
0
0
7
0
0
0
1
3
[1
0
]
Jo
se
p
h
,
J.
El
.
,
a
n
d
S
h
ij
u
,
M
a
th
e
w
,
“
T
h
e
Eff
ica
c
y
o
f
th
e
in
teg
ra
ted
c
h
il
d
d
e
v
e
lo
p
m
e
n
t
se
rv
ice
s
in
p
e
rsp
e
c
ti
v
e
to
n
u
tri
t
io
n
a
l
c
o
n
d
it
io
n
a
n
d
g
ro
w
th
d
e
v
e
lo
p
m
e
n
t,
”
In
ter
n
a
ti
o
n
a
l
J
o
u
rn
a
l
o
f
Pu
b
li
c
He
a
lt
h
S
c
ien
c
e
,
v
o
l.
4
,
n
o
.
1
,
pp.
17
-
2
0
,
2
0
1
5
,
d
o
i
:
h
tt
p
:/
/d
o
i.
o
r
g
/1
0
.
1
1
5
9
1
/i
jp
h
s.v
4
i
1
.
4
7
0
6
.
[1
1
]
Ch
e
ry
l,
A
.
A
l.
,
a
n
d
L
id
o
n
g
,
W
.
,
“
P
u
b
li
c
He
a
lt
h
P
r
o
m
o
ti
o
n
:
A
u
to
n
o
m
y
o
f
th
e
E
m
e
r
g
e
n
c
y
Nu
rse
P
ra
c
ti
ti
o
n
e
r
,
”
In
ter
n
a
t
io
n
a
l
J
o
u
rn
a
l
o
f
P
u
b
li
c
He
a
l
th
S
c
ien
c
e
,
v
o
l.
4
,
n
o
.
1
,
p
p
.
17
-
2
0
,
2
0
1
5
,
d
o
i
:
h
tt
p
:
//
d
o
i.
o
rg
/1
0
.
1
1
5
9
1
/i
jp
h
s.v
4
i1
.
4
7
0
8
.
[1
2
]
F
a
rh
a
n
a
,
J.
A
r
e
t
a
l.
,
“
Ro
le
o
f
m
o
th
e
rs’
n
u
tri
ti
o
n
a
l
k
n
o
w
led
g
e
,
n
u
tri
ti
o
n
a
l
f
a
c
to
rs
o
n
th
e
sc
h
o
o
l
p
e
r
f
o
r
m
a
n
c
e
,”
In
ter
n
a
t
io
n
a
l
J
o
u
rn
a
l
o
f
P
u
b
li
c
He
a
l
th
S
c
ien
c
e
,
v
o
l.
4
,
n
o
.
1
,
p
p
.
44
-
4
9
,
2
0
1
5
,
d
o
i
:
h
tt
p
:
//
d
o
i.
o
rg
/1
0
.
1
1
5
9
1
/i
jp
h
s.v
4
i1
.
4
7
1
0
.
[1
3
]
A
ri
y
a
n
i,
D
w
i
F
.
,
a
n
d
Ha
n
d
a
y
a
n
i
L
.
,
“
Co
n
tri
b
u
ti
o
n
F
a
c
to
rs
o
n
E
a
rl
y
In
it
iatio
n
o
f
Bre
a
st
f
e
e
d
in
g
,
”
In
ter
n
a
ti
o
n
a
l
J
o
u
rn
a
l
o
f
P
u
b
li
c
He
a
l
th
S
c
ien
c
e
,
v
o
l.
4
,
n
o
.
3
,
p
p
.
1
9
2
-
1
9
6
,
2
0
1
5
,
d
o
i:
h
tt
p
:/
/
d
o
i.
o
rg
/1
0
.
1
1
5
9
1
/i
j
p
h
s.
v
4
i3
.
4
7
3
2
.
[1
4
]
Ag
ri
m
o
n
,
H.
O.,
a
n
d
S
tree
t,
J.,
“
De
v
e
lo
p
in
g
Co
m
p
re
h
e
n
siv
e
Dia
b
e
tes
Ed
u
c
a
ti
o
n
M
a
teria
ls
f
o
r
S
tru
c
tu
re
d
P
a
ti
e
n
t
Ed
u
c
a
ti
o
n
P
r
o
g
ra
m
s
in
P
rim
a
r
y
C
a
re
S
e
tt
in
g
,
”
In
ter
n
a
ti
o
n
a
l
J
o
u
r
n
a
l
o
f
Pu
b
li
c
He
a
lt
h
S
c
ien
c
e
,
v
o
l.
5
,
n
o
.
1
,
p
p
.
16
-
2
6
,
2
0
1
6
,
d
o
i:
h
tt
p
:/
/
d
o
i.
o
rg
/1
0
.
1
1
5
9
1
/
ij
p
h
s.v
5
i1
.
4
7
5
8
[1
5
]
Rik
a
w
a
ra
stu
ti
,
R
e
t
a
l.
,
“
P
e
ri
o
d
o
n
tal
Dise
a
se
o
n
P
re
g
n
a
n
t
W
o
m
e
n
(Ca
se
S
tu
d
y
:
P
o
n
d
o
k
L
a
b
u
V
i
ll
a
g
e
,
S
o
u
t
h
Ja
k
a
rta,
In
d
o
n
e
sia
)
,
”
In
ter
n
a
ti
o
n
a
l
J
o
u
r
n
a
l
o
f
P
u
b
li
c
He
a
lt
h
S
c
i
e
n
c
e
,
v
o
l.
5
,
n
o
.
2
,
p
p
.
1
7
0
-
1
7
5
,
2
0
1
6
,
d
o
i:
h
tt
p
:
//
d
o
i.
o
rg
/1
0
.
1
1
5
9
1
/i
jp
h
s.v
5
i2
.
4
7
8
2
.
[1
6
]
In
a
y
a
h
,
L
.
A
e
t
a
l.
,
“
Ev
a
lu
a
ti
o
n
o
f
lac
tatio
n
p
ro
m
o
ti
o
n
a
s
p
a
rt
o
f
b
a
b
y
f
rien
d
l
y
h
o
sp
it
a
l,
”
In
ter
n
a
ti
o
n
a
l
J
o
u
rn
a
l
o
f
Pu
b
li
c
He
a
lt
h
S
c
ien
c
e
,
v
o
l.
6
,
n
o
.
1
,
p
p
.
45
-
5
0
,
2
0
1
7
,
d
o
i:
1
0
.
1
1
5
9
1
/.
v
6
i1
.
6
5
3
1
[1
7
]
P
e
e
v
,
S
t.
,
a
n
d
S
a
b
e
v
a
,
El
.
,
“
Bo
n
e
b
lo
c
k
a
u
g
m
e
n
tatio
n
-
a
lo
n
g
-
term
f
o
ll
o
w
-
up,
”
S
c
rip
ta
S
c
ien
t
if
ica
M
e
d
icin
a
e
De
n
ta
li
s
,
v
o
l
.
4
,
n
o
.
2
,
p
p
.
2
9
-
3
5
,
2
0
1
8
.
[1
8
]
L
e
v
in
,
L
e
t
a
l.
,
“
T
h
e
u
se
o
f
a
se
lf
-
re
p
o
rt
q
u
e
sti
o
n
n
a
ire
f
o
r
d
e
n
tal
h
e
a
lt
h
sta
tu
s
a
ss
e
ss
m
e
n
t:
a
p
re
li
m
in
a
r
y
stu
d
y
,
”
Brit
ish
De
n
t
a
l
J
o
u
rn
a
l
,
v
o
l
.
2
1
4
,
n
o
.
5
,
p
.
E1
5
,
2
0
1
3
,
d
o
i:
d
o
i
:
1
0
.
1
0
3
8
/sj.
b
d
j.
2
0
1
3
.
2
2
4
.
[1
9
]
Dim
o
v
a
,
A
e
t
a
l.
,
“
He
a
lt
h
sy
ste
m
s
in
T
ra
n
siti
o
n
,
”
v
o
l.
20
,
n
o
.
4
,
2
0
1
8
.
[
O
n
li
n
e
]
.
A
v
a
il
a
b
le:
h
tt
p
:
//
ww
w
.
e
u
ro
.
w
h
o
.
in
t
/_
_
d
a
ta/a
ss
e
ts/p
d
f
_
f
il
e
/0
0
0
5
/
3
8
3
0
5
4
/HiT
-
Bu
lg
a
ria
-
2
0
1
8
-
w
e
b
.
p
d
f
?
u
a
=
1
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N:
2
2
5
2
-
8
8
0
6
I
n
t.
J
.
P
u
b
lic
Hea
lth
Sci.
,
Vo
l.
1
0
,
No
.
2
,
J
u
n
e
20
21
:
2
5
8
–
2
6
4
264
[2
0
]
Dim
o
v
a
-
G
a
b
ro
v
sk
a
e
t
a
l.
,
“
Qu
e
stio
n
n
a
ire
su
rv
e
y
o
f
f
ix
e
d
c
ro
wn
p
ro
st
h
e
ti
c
trea
tme
n
t
in
c
h
il
d
r
e
n
,
”
J
o
u
rn
a
l
o
f
IM
AB
,
v
o
l.
25
,
n
o
.
3
,
p
p
.
2
6
7
5
-
2
6
7
8
,
2
0
1
9
.
[2
1
]
Dim
o
v
a
-
G
a
b
ro
v
sk
a
e
t
a
l.
,
“
A
d
v
a
n
tag
e
s
a
n
d
d
isa
d
v
a
n
tag
e
s
o
f
p
a
e
d
iatric
c
ro
w
n
p
ro
sth
e
t
ic
trea
tme
n
t
,
”
J
o
u
r
n
a
l
o
f
IM
AB
,
v
o
l.
25
,
n
o
.
3
,
p
p
.
2
6
9
5
-
2
7
0
0
,
2
0
1
9
.
[2
2
]
Dim
o
v
a
,
E.
,
D
o
ich
i
n
o
v
a
,
L
,
a
n
d
A
n
d
re
e
v
a
-
Bo
riso
v
a
,
R.
,
“
De
n
ti
sts`
Aw
a
re
n
e
ss
o
f
w
h
it
e
sp
o
t
les
io
n
s
d
u
rin
g
trea
t
m
e
n
t
w
it
h
f
ix
e
d
o
rth
o
d
o
n
t
ic
a
p
p
li
a
n
c
e
s,”
M
e
d
in
f
o
rm
,
v
o
l.
7
,
n
o
.
1
,
p
p
.
1
1
5
6
-
1
1
6
4
,
2
0
2
0
.
[2
3
]
S
o
k
o
lsk
a
y
a
,
M
.
V
e
t
a
l.
,
“
T
h
e
e
ff
e
c
t
o
f
p
e
rso
n
a
l
h
e
a
lt
h
o
n
th
e
f
o
rm
a
ti
o
n
o
f
h
u
m
a
n
c
a
p
it
a
l:
a
m
e
tas
y
st
e
m
a
p
p
ro
a
c
h
,
”
In
ter
n
a
t
io
n
a
l
J
o
u
rn
a
l
o
f
P
u
b
li
c
H
e
a
lt
h
S
c
ien
c
e
(
IJ
PHS
)
,
v
o
l.
8
,
n
o
.
1
,
p
p
.
1
3
5
-
1
4
2
,
2
0
1
9
.
[2
4
]
P
e
c
k
h
a
m
,
S
t
e
t
a
l.
,
“
He
a
lt
h
p
ro
m
o
ti
o
n
a
n
d
d
ise
a
se
p
re
v
e
n
ti
o
n
i
n
g
e
n
e
ra
l
p
ra
c
ti
c
e
a
n
d
p
rim
a
r
y
c
a
re
:
a
s
c
o
p
in
g
stu
d
y
,
”
Ca
mb
rid
g
e
c
o
re
,
v
o
l.
1
8
,
n
o
.
6
,
p
p
.
5
2
9
-
5
4
0
,
2
0
1
7
.
[2
5
]
Zaf
iro
p
o
u
l
o
s,
G
.
,
“
Ed
u
c
a
ti
o
n
a
l
p
ro
g
ra
m
m
e
s:
S
a
v
in
g
m
o
n
e
y
in
h
e
a
lt
h
c
a
re
,
”
Brit
ish
J
o
u
rn
a
l
o
f
He
a
lt
h
c
a
r
e
M
a
n
a
g
e
me
n
t
,
v
o
l.
2
1
,
n
o
.
1
2
,
p
p
.
5
7
1
–
5
7
6
,
2
0
1
5
.
[2
6
]
Da
m
y
a
n
o
v
a
,
Do
b
ri
n
k
a
,
“
Re
p
o
rt
i
n
g
c
a
ries
in
t
h
e
sta
g
e
o
f
d
e
stru
c
t
io
n
-
d
3
m
f
t/
s+
d
4
m
f
t/
s
,
”
IOS
R
J
o
u
rn
a
l
o
f
De
n
t
a
l
a
n
d
M
e
d
ica
l
S
c
ien
c
e
s (
IOS
R
-
J
D
M
S
)
,
v
o
l.
1
6
,
n
o
6
(v
ii
)
,
p
p
.
9
3
-
9
6
,
2
0
1
7
.
[2
7
]
T
o
o
th
M
o
u
ss
e
-
Bio
-
a
v
a
il
a
b
le
c
a
lciu
m
a
n
d
p
h
o
sp
h
a
te,
w
it
h
o
u
t
f
lu
o
ri
d
e
,
G
C
EUROP
E
A
.
G
.
,
2
0
2
0
.
[
On
li
n
e
].
Av
a
il
a
b
e
:
h
tt
p
s:/
/eu
ro
p
e
.
g
c
.
d
e
n
ta
l/
b
g
BG
/p
ro
d
u
c
ts/t
o
o
th
m
o
u
ss
e
[2
8
]
Ha
ji
sh
e
n
g
a
ll
is
,
E
e
t
a
l.
,
“
A
d
v
a
n
c
e
s
in
th
e
m
icro
b
ial
e
ti
o
lo
g
y
a
n
d
p
a
th
o
g
e
n
e
sis
o
f
e
a
rl
y
c
h
i
ld
h
o
o
d
c
a
ries
,
”
M
o
lec
u
la
r
Or
a
l
M
icr
o
b
io
l
ogy
,
v
o
l.
32
,
n
o
.
1
,
p
p
.
24
-
34
,
2
0
1
7
,
d
o
i:
1
0
.
1
1
1
1
/
o
m
i.
1
2
1
5
2
.
E
p
u
b
2
0
1
6
F
e
b
4
.
[2
9
]
F
a
k
h
ru
d
d
in
,
K
.
S
.
,
Ng
o
,
H.
C
,
a
n
d
S
a
m
a
ra
n
a
y
a
k
e
,
L
.
P
,
“
Ca
rio
g
e
n
ic
m
icro
b
io
m
e
a
n
d
m
icro
b
io
ta
o
f
th
e
e
a
rl
y
p
rim
a
r
y
d
e
n
ti
ti
o
n
:
A
c
o
n
tem
p
o
ra
ry
o
v
e
r
v
ie
w
”
,
O
ra
l
Dis
e
a
s
e
,
v
o
l.
2
5
,
n
o
.
4
,
p
p
.
9
8
2
-
9
9
5
,
2
0
1
9
,
d
o
i
:
1
0
.
1
1
1
1
/
o
d
i.
1
2
9
3
2
.
[3
0
]
He
m
a
d
i,
A
.
S
.
,
Hu
a
n
g
R.
,
Zh
o
u
,
a
n
d
Y.,
Z
o
u
,
J.
,
“
S
a
li
v
a
r
y
p
ro
tein
s
a
n
d
m
icro
b
i
o
ta
a
s
b
io
m
a
rk
e
rs
f
o
r
e
a
rl
y
c
h
il
d
h
o
o
d
c
a
ries
risk
a
ss
e
ss
m
e
n
t
,”
In
t
e
rn
a
ti
o
n
a
l
J
o
u
r
n
a
l
Or
a
l
S
c
i
e
n
c
e
,
v
o
l.
9
,
n
o
.
11
,
2
0
1
7
,
d
o
i
:
1
0
.
1
0
3
8
/
ij
o
s.
2
0
1
7
.
3
5
.
[3
1
]
P
a
lm
e
r
,
C
.
A
e
t
a
l.
, “
Die
t
a
n
d
c
a
ri
e
s
-
a
ss
o
c
iate
d
b
a
c
teria
in
se
v
e
r
e
e
a
rl
y
c
h
il
d
h
o
o
d
c
a
ries
,
”
J
o
u
rn
a
l
De
n
t
al
Res
e
a
rc
h
,
v
o
l.
89
,
n
o
.
11
,
p
p
.
1
2
2
4
-
9
,
2
0
1
0
,
d
o
i:
1
0
.
1
1
7
7
/0
0
2
2
0
3
4
5
1
0
3
7
6
5
4
3
.
[3
2
]
Da
m
y
a
n
o
v
a
,
D
a
n
d
A
n
d
re
e
v
a
-
B
o
riso
v
a
,
R.
,
“
A
n
a
l
y
sis
o
f
T
h
e
ra
p
e
u
ti
c
Ef
f
ic
a
c
y
o
f
Cli
n
ica
ll
y
A
p
p
li
e
d
V
a
rn
ish
,
”
De
n
ta
l
Res
e
a
rc
h
a
n
d
Or
a
l
He
a
lt
h
,
v
o
l.
1
,
n
o
.
2
,
p
p
.
0
2
2
-
0
2
8
,
2
0
1
8
,
d
o
i:
1
0
.
2
6
5
0
2
/
d
ro
h
.
0
0
4
[3
3
]
Ka
w
a
sh
it
a
,
Y
e
t
a
l.
,
“
Early
Ch
il
d
h
o
o
d
Ca
ries
,
”
In
t
e
rn
a
ti
o
n
a
l
J
o
u
r
n
al
o
f
De
n
t
al
,
v
o
l.
2
0
1
1
,
p
.
7
,
h
tt
p
s:/
/d
o
i.
o
rg
/1
0
.
1
1
5
5
/2
0
1
1
/7
2
5
3
2
0
Evaluation Warning : The document was created with Spire.PDF for Python.